Provider Demographics
NPI:1114698487
Name:POIDOMANI, DAVID JAVIER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAVIER
Last Name:POIDOMANI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 SW CASCADE FALLS DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7172
Mailing Address - Country:US
Mailing Address - Phone:630-301-8801
Mailing Address - Fax:
Practice Address - Street 1:2135 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4592
Practice Address - Country:US
Practice Address - Phone:515-964-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist